Friday, June 29, 2018

The Dangers of Oral Piercings

Today's article is from studies that were recently presented at the European Federation of Periodontology’s EuroPerio9 conference, June 20 to June 23 in Amsterdam.  
Though considered trendy and fashionable in some circles, tongue piercings may affect nearby gums and teeth.  We have seen multiple cases in our practice of  severe damage to the periodontium from these fashion statements. In some cases the damage occurred very quickly, within the first months of the piercing.  
“My interest in piercings began when a young female patient presenting unusually severe periodontal destruction was referred to my clinic,” said Clemens Walter, DMD, of the Department of Periodontology, Endodontology, and Cariology at the University of Basel in Switzerland and author of the first study.
“The patient was periodontally healthy with the exception of the lower incisor teeth. We could not identify any known risk factors. The patient had a tongue piercing. Nonsurgical and advanced surgical treatment was performed and was not successful. The patient lost teeth. Since then, I have been curious about this association and started to collect cases,” Walter said.
The 18 subjects in Walter’s study, including 14 females, were drawn from a database of more than 1,400 patients treated at the university. The mean age was 28.3 years, ±7.7 years. Three of the patients wore both a lip and a tongue piercing, for a total of 14 tongue piercings and seven lip piercings.
Clinical parameters and the maximum wearing time of the lip and/or tongue piercing were recorded. Periodontal findings in the teeth close to the piercing were compared to teeth not affected by the piercing.
“Due to ethical considerations, it seems impossible to conduct a prospective study. Therefore, the suitable design to answer our question was a retrospective study/case series,” said Walter.
“We found an association between oral piercings and increased periodontal inflammation, as evident by increased bleeding on probing and increased probing depth and/or attachment loss. The closer teeth were to a tongue piercing, the more affected they were,” said Walter. 
recession and bone loss caused by a lip piercing
“Acknowledging the growing data from all over the world, we now try to create awareness about the consequences of piercings for oral health, and we counsel our patients to remove piercings in order to decrease the risk for dental and periodontal complications,” said Walter.
Dr. Bernard Loir of Brussels found repeated gum damage due to the chronic pressure of metal against teeth and gums during tongue movements in speaking, eating, or swallowing in a pair of female patients, age 27 and 32. 
This gum damage also was associated with gum bleeding and infection, causing deep lingual infrabony lesions and periodontitis. The tongue piercings were used for eight to 10 years and finally removed after abscesses, teeth mobility, and migration.
“The lesions were localized on the lower incisor’s lingual side, close to a tongue piercing (the most frequent oral localization of these devices, followed by the lip),” said Loir.
“Periodontal complications occurred in a location hardly visible for the patient, and as these teeth have very short roots, tooth mobility and tooth loss in the aesthetic area may be quickly encountered, an uncomfortable situation for such young and mostly female patients,” said Loir. 
“For both patients, time consuming and costly surgical treatment and antibiotics were needed, and complete regeneration of the lost tissue could not be achieved,” Loir said.
“Young patients with oral piercings should be made aware of the local and global health risks they take by wearing these useless devices, especially if they compound the risk by smoking and a lack of proper dental hygiene. Piercings interfere daily with chewing, swallowing, and speaking, and the rate of complications is very high in the available literature,” said Loir. 
“Early complication is usually infection due to lack of hygiene in the piercing saloon or when done by the patients themselves with nonsterile material. Bleeding and swelling of the tongue is also very common and may represent a danger for a patient with cardiovascular disease, but late complications also occur, such as swallowing the jewelry, teeth chipping, and gum recession with lip piercings,” Loir said. 
“Other complications occur in a more silent mode, such as lingual gum recession and bone loss, causing tooth mobility, migration, and loss. Other life-threatening diseases such as viral contamination (hepatitis, papilloma virus), endocarditis, and cerebral abscesses have also been registered,” said Loir.
“While awareness with respect to oral complications associated with piercings seems to be slowly increasing, there is yet much to be done,” said Walter. “We are continuing with our research and hope to recruit more patients in order to increase our database.”

My advice to all people considering a perioral or tongue piercing is very simple, just don't do it. And for all those who have already taken the leap and had the piercing done, your best bet it to promptly remove it. If you've noticed any changes in the condition of your gum near your piecing make an appointment with a periodontist to get the damaged treated, it might not be too late to save the affected teeth.

Friday, June 22, 2018

Possible Gene found which controls periodontal disease

Study pinpoints genetic connections to perio and coronary artery disease in addition to lifestyle factors

Results of a meta-analysis presented at the European Federation of Periodontology-EuroPerio9 meeting reported that periodontal disease and coronary artery disease (CAD) share a common genetic basis. 
“Knowledge of the shared genetic basis helps to understand the molecular mechanisms that underlie and predispose to the disease,” explained lead author, Dr. Arne S Schäfer, a professor at the department of periodontology and synoptic dentistry based at Charité University Medicine in Berlin, Germany. “This knowledge will guide strategies for therapy but also allow the identification of risk groups for preventive care, before the disease manifests itself.”
Strong evidence of association between CAD and periodontal disease (PD) has already been established. Both are among the most common diseases: CAD affects 110 million people worldwide and is the first cause of death, while PD affects 538 million people.(2) Both diseases are frequently diagnosed together and have common risk factors, such as smoking and diabetes. Both are characterised by a chronic inflammatory process but, independent of those shared risk factors, previous studies(3,4) had suggested a few shared genetic variants.
Dr. Schäfer said, “Our aim in undertaking this study was to further explore the joint genetic basis of CAD and PD. The identification of the shared genetic susceptibility factors will pinpoint relevant molecular pathways for the disease. This knowledge will yield very specific therapeutical targets for precision medicine. We believed that, given the localized nature of periodontitis which is confined to the oral cavity, there would be a small variety of different pathways that had the potential to contribute to both diseases.”
He added that the 10-year study examined every common variant in the entire DNA sequence. “These are alternative building blocks called alleles, which are in the millions. We counted if a variant was more common in both CAD and periodontitis cases, compared to healthy controls,” he said. To rule out chance findings, which can be caused by random differences of natural variation, we counted all these variants in all patients of CAD and periodontitis that were available to us. This high number of analyzed individuals and a replication of the results in an independent sample of cases and controls, allows to generalize our findings.”
Researchers identified a variant in the promoter region of the gene VAMP8 (a promoter regulates the activity of a gene in response to other stimuli) to be significantly more frequent in CAD and periodontitis cases than in healthy controls, indicating the involvement of this gene in the etiology of both diseases.
“VAMP8 is of special interest, because it is involved in the import and export of molecules and other substances into and out of the cells (acting as a sort of door),” Dr. Schäfer said. “It is strongly expressed in the epidermis of cellular interfaces of barrier organs of the gastrointestinal tract, which includes the gingiva. We are now looking in detail at which direction the transport is affected in the disease processes and what substances are involved, for example microbial substances that get in or antimicrobial substances that get out of the gut.”
Asked for a “take home” message, Dr. Schäfer said that it is important to retain that coronary artery disease and gum disease are not linked to lifestyle factors alone. “There are probably risk groups which have a genetic predisposition in response to certain factors,” he replied. “This also means that periodontitis does not increase the risk for CAD in general or vice versa. Nevertheless, a group of individuals may share a genetic predisposition, involving the VAMP8 function, which increases the risk for both diseases. While it is possible that one disease precedes the onset of the other, that does not necessarily mean that the manifestation of one causes the manifestation of the second disease.”
The European Federation of Periodontology is an umbrella organization of 30 national scientific societies devoted to promoting research and education for periodontal science and practice. EuroPerio9 will hosted June 20- 23 at the RAI in Amsterdam.

Article originally published by Dentistry IQ 6-15-18

Friday, June 15, 2018

Home Grown Research Team develops early detection for gum disease!

“Smart Tooth” Detects Periodontitis

Researchers from the Washington University School of Medicine in St. Louis and the School of Engineering & Applied Science are developing “smart tooth” technology that could be used to detect the early signs of certain diseases such as periodontitis and diabetes in high-risk patients by analyzing saliva or gingival crevicular fluid. 
“Salivary-based biosensors have generated a lot of interest because of their potential for wide applications in medicine,” said Erica Lynn Scheller, DDS, PhD, assistant professor of medicine, cell biology, and physiology at the School of Medicine. “We’re initially working to develop a biological sensor that measures specific peptides active in periodontal disease, and that would be used in combination with a wireless device to retrieve that data.” 
“It’s like an electronic tooth,” said Shantanu Chakrabartty, MS, PhD, professor of electrical and systems engineering in the School of Engineering & Applied Science and a partner on the project, currently funded by a four-year, $1.5 million grant from the National Institutes of Health.
The “smart tooth” is a tiny sensor and electronic chip that’s about a few millimeters cubed in volume. Designed to be inserted inside the gumline or as part of a dental appliance, it features bio-recognition elements that measure disease-specific peptides, which are natural or synthetic groups of amino acids. 
As a first attempt, the researchers will work toward monitoring peptides related to bone breakdown in periodontitis. A wireless ultrasound device would then read the peptide levels and connect to the medical data cloud. However, chemistry remains one of the project’s biggest challenges.
“You only have a finite number of bio-recognition elements conjugated to the transducer if you are using an antibody that is specific to these peptides,” said Srikanth Singamaneni, MS, PhD, associate professor of mechanical engineering and materials science. “They get saturated fairy quickly. The question is, how do you refresh those sensors? That’s one of the aspects we are working to address with this project.” 
The researchers say that developing a new, minimally invasive system that can detect and monitor gum disease and the effectiveness of treatment would be beneficial to the 64 million United States residents with periodontal disease and to their dentists. Also, the researchers are interested in developing other applications for the technology that, while likely years away, could go well beyond the dentist’s chair.
“We’re developing this sensing platform that can be expanded to include additional tracking for inflammatory markers, stress markers, and diabetes monitoring,” said Scheller. “Really, anything you can think of that you’d want to track in the oral cavity, we’re developing both the platform and the specific application.”